Provider Demographics
NPI:1710293071
Name:KALYANARAMAN, NISHA (PT)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:KALYANARAMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18340 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-5008
Mailing Address - Country:US
Mailing Address - Phone:248-442-0030
Mailing Address - Fax:248-442-2073
Practice Address - Street 1:18340 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-5008
Practice Address - Country:US
Practice Address - Phone:248-442-0030
Practice Address - Fax:248-442-2073
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist